Provider First Line Business Practice Location Address:
GEORGE MOTCHAN DETENTION CENTRE CORRECTIONAL FACILITY
Provider Second Line Business Practice Location Address:
15-15 HAZEN STREET
Provider Business Practice Location Address City Name:
EAST ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-774-7462
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2020